Settling the Score

Calcium scoring may be the best indicator yet to assess your risk of heart attack.

Cholesterol, blood pressure, weight—you can probably tick off all of these statistics. But if you don’t know your calcium score, you may be skipping a beat with your heart health.

“I was a mystery,” says Robert Swinarton of Kenilworth. The active 60-year-old began experiencing some chest pain last summer and into fall, but he dismissed it as nothing. After all, he says, “I had passed everything, even a stress test, with flying colors.” It wasn’t until his cardiologist ordered a coronary calcium test (CCT)—a noninvasive CT scan that images the buildup of calcium in plaque within the coronary arteries—that the mystery was solved: Swinarton’s CCT showed significant coronary calcification, which led to a cardiac catheterization that revealed an 80 percent blockage in one of his arteries. In December he underwent a stenting procedure to open the blockage, putting the skier back on the slopes with his daughters and grandchildren just weeks later. “I’m relieved that my problem was found and fixed,” he says. “I was fortunate to have come across the right people, and I feel great.”

Anyone who hears a story like Swinarton’s is likely to wonder, Should I get a coronary calcium test too? For the answer, read on….

Understanding CCT

Calcium is an essential ingredient of plaque, and plaque clogs arteries, explains Robert Fishberg, MD, FACC, of Associates in Cardiovascular Disease. When we’re born, there is no calcium in our arteries; it develops as we age (and is unrelated to calcium intake from milk products and other foods). Calcium in the coronaries is a marker for plaque formation. The higher the calcium score, the greater the overall coronary plaque burden.

A coronary calcium test provides an actual visualization of calcified plaque in the coronary arteries. The test requires only a single pass through a CT. At Overlook, this is done with a 320-slice scanner—the fastest and clearest technology available—and protocols are observed in order to minimize exposure to radiation. A cardiologist then examines the images, looking for any calcium deposits and inflammation within the arteries of the heart (images are also reviewed by a radiologist who visualizes the area outside the heart, looking for abnormalities within the lungs and anywhere else). “We map the calcium and assign an internationally accepted score to each artery,” explains Sidney Glasofer, MD, FACC, also of Associates in Cardiovascular Disease. “We risk-stratify patients by age and gender, so we score a 40-year-old man differently than a 65-year-old woman—the meanings are totally different.” In all populations, however, the presence of calcium in coronary arteries is a significant risk factor for coronary artery disease, and the higher the calcium score, the higher the risk of heart attack, stroke, or death.

CCT is often a more accurate assessment of risk than a stress test. For a stress test to be positive, there must be a blockage greater than 70 percent; however, most heart attacks occur from a rupture of a coronary plaque that was originally less than 50 percent, says Fishberg. The goal, then, is to use other factors to identify patients who may be at higher risk for heart attack or sudden death, and CCT can be a powerful determining factor. Although a comprehensive lipid profile remains the first test for assessing risk, CCT should be considered for anyone who is concerned about their risk for heart attack. CCT is recommended for men over 40 and for post-menopausal women (for the latter, Fishberg reports that any degree of calcium is significant). The test should also be considered for those with a strong family history of high LDL cholesterol or coronary artery disease (particularly for anyone whose father had a heart attack before age 55, or whose mother had a heart attack before age 65), or those with metabolic syndrome.

The test also can be beneficial for patients with high cholesterol who are not sure if they want to be treated for the condition, or how aggressively they want to be treated. “Many people don’t want to take statins to lower their cholesterol unless they have to,” says Fishberg. “Patients are happy to learn that they may not need to take a statin if their calcium score is low and they are truly at low risk for a heart attack.”

Adds Glasofer, “CCT is a very useful test for risk stratification, especially in patients of moderate risk and patients with a strong family history of coronary artery disease, because this factor is left off of risk models. When I see a patient with a strong family history and borderline cholesterol levels, I use calcium scoring to get a better assessment. Calcium scoring is a test that should be used in an asymptomatic population of moderate cardiac risk if it is going to change their risk management.” In other words, if calcium scoring will reclassify one’s risk profile or change how a person manages risk—whether it’s with statins, aspirin, or lifestyle changes—the test has clear benefits.

Also shown to benefit greatly from coronary calcium tests are firefighters, Fishberg points out. “Firefighters have 300 percent more heart disease than other professionals, and 45 percent of firefighters’ on-duty deaths are cardiac-related,” he reports. “A recent study showed that 36 percent of asymptomatic firefighters over 40 have coronary calcification by CCT, and 19 percent had undiagnosed three-vessel disease, placing them at high risk for a cardiovascular event.” Because a coronary calcium score will diagnose a firefighter at risk for a myocardial infarction or sudden death before tragedy strikes, CCT is recommended for every male firefighter over 40 (over 35 for a firefighter with cardiac risk factors).

Unfortunately, barriers to coronary calcium testing remain. The test is not available everywhere, nor is it typically covered by insurance plans. Overlook is helping to remove those barriers by offering CCT for a reduced cost of just $99—as low as or lower than anywhere in the state. “We’re committed to prevention,” says Fishberg. “We want to do this before someone has a heart attack, so we can make a real difference in their life.”

For more information about coronary calcium testing or to inquire about an appointment, call Associates in Cardiovascular Disease in Springfield (973-467-0005) or New Providence (908-464-4200).

Settling the Score